The President's Emergency Plan for AIDS Relief, which was submitted to Congress last month, details the Bush administration's five-year, $15 billion global AIDS initiative, which seeks to prevent seven million new HIV infections, provide care for 10 million people living with the disease and provide treatment to two million HIV-positive people living in 14 African and Caribbean countries. Representatives of FDA, the World Health Organization, UNAIDS and other groups at a meeting in Botswana this week are discussing proposals regarding the regulation of generic antiretroviral drugs for use in both the U.S. plan and other initiatives (Kaiser Daily HIV/AIDS Report, 3/29). Summaries of several newspaper editorials and an opinion piece appear below:

Editorials

Akron Beacon Journal: Although "momentum" appeared to be building in the move to ensure access to antiretroviral drugs for people in developing countries, WHO estimates that only 300,000 of the six million people who need the drugs are receiving them, a Beacon Journal editorial says. The Bush administration's funding record has been "[d]iscouraging"; the promise of low-priced, generic antiretrovirals has proved "elusive," and the Global Fund to Fight AIDS, Tuberculosis and Malaria is "seriously underfunded," the editorial says, concluding, "Unless the momentum to raise funds and increase the flow of cheap antiretrovirals can be sustained, the hope of easing the burden of HIV/AIDS in developing countries w[ill] fade" (Akron Beacon Journal, 3/30).

Raleigh News & Observer: "Wealthy nations, including the United States, have held tight to their wallets, starving the Global Fund ... near to the point of collapse," a News & Observer editorial says. Congress "[a]t a minimum" must "move quickly" to ensure that WHO's plan to have three million people on treatment by 2005 stays "on track" and should enact legislation to "bac[k] a World Trade Organization agreement" that allows developing countries with public health crises to import generic antiretrovirals, the editorial says, concluding, "That's the sort of leadership the world expects from the United States and prominent corporations here [and] ... [w]ith so many millions of lives at stake, doing less is unthinkable" (Raleigh News & Observer, 3/30).

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Rochester Democrat and Chronicle: President Bush "did the right thing" in committing to fighting global AIDS but now must "back up his words" by taking the lead in getting generic drugs, which "have proved both safe and effective, ... into wider use," a Democrat and Chronicle editorial says. "Bush's promise to commit billions of dollars to the AIDS fight in poor nations is one of the highlights of his first term. But the highlight will become a lowlight if he fails to follow through," the editorial concludes (Rochester Democrat and Chronicle, 3/30).

San Francisco Chronicle: The campaign to provide antiretroviral drugs to people in developing countries is falling "far short of expectations," a Chronicle editorial says. Although the plan "should be getting a huge boost" from PEPFAR, Bush has "only requested from Congress a fraction of what he originally promised" and has "throw[n] up another stumbling block" by requiring that generic drugs meet certain standards set by FDA, the editorial says, concluding that the groups meeting in Botswana should "move quickly to resolve" the "unnecessary fight" over the regulation of generics because "[m]illions of lives are at stake" (San Francisco Chronicle, 3/30).

Opinion Piece
Although the prospect of generic fixed-dose combination antiretroviral drugs "holds great appeal for patients in Africa and across the globe," it is important that the decision of whether to dispense these drugs through PEPFAR be made on the basis of science, Abner Mason, executive director of the AIDS Responsibility Project and chair of the international subcommittee of the Presidential Advisory Council on HIV/AIDS, writes in a San Francisco Chronicle opinion piece. These "unproven products," which have passed WHO's "prequalification" system but have not been approved by FDA, could cause "serious side effects and could promote the development of resistant strains of HIV," Mason says. "With millions of lives at stake and $15 billion in taxpayers' dollars on the line, U.S. officials in Botswana must insist on standards of safety, ... take caution in embracing" the drugs and avoid "[p]utting cost ahead of efficacy," Mason concludes (Mason, San Francisco Chronicle, 3/29).

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